roberman

I ran 9 prenatals which were negative with R643 using R630 strips. 2 were neg, 2 were pos and 5 were No Int. Most of our problems seem to be with pregnant women. Immucor is replacing them for us, pending approval.

Our QC has been fine. The patients have been the problem. And the majority (70% ish) of the problem patients are prenatals. Our backup is gel which has been negative for all of them. But in the last few months we've had 2 weak (1-2+) positive Echo screens which were negative on gel and turned out to be anti-E per our reference lab. Immucor is sending us a new lot of indicator cells to try with both of our RS3 lots.

We're having a lot more NO INTs than usual with R630. Lot R643 is only slightly better. I have run them both against 2 different lots of indicator cells. Lots of ?s in mainly cell 2.

Same here.

We test it on our blood gas analyzer.

2 months ago, a patient came in with just a blood type order. She typed as A neg on the Echo. We didn't do a 2nd type since we only do them on pts receiving products or T&Ss. Last week she came in for a pre-op T&S and she typed as A pos (3+ with both anti-Ds on the Echo) as well as with tubes. We had her return for a redraw with the same results. We scrutinzed all the work done on the Echo on that day 2 months ago. We ruled out pt mixups, clerical errors, reagent issues, QC problems, etc. The specimen tube ID had not been hand entered (It was barcode read.), nor had the results been edited. Thinking it might be WBIT, I pulled the CBC results from both visits to look at indices, plts, etc. The 2 results from 2 months apart were virtually identical. Her diagnosis was carcinoma in-situ. She was not on chemo and had not had any transfusions during the previous months. Any ideas??? Thanks! Robin

Last year I got superhero wall decals on Amazon and superimposed employee faces on them and then stuck them up around the lab. (Some are still on the lockers.) We usually have a factoid game where staff submits an interesting tidbits about themselves and we have to guess who. This year we're matching up dream jobs, posters you had on your wall growing up and comments that were written on your report cards. We might have slide olympics where we vote on the best feathered edge. Guess the crit...spin down various EDTA tubes after running them through the Coulter. Normal word games that can be generated for free on various web sites - jumble, word search, sudoku with words. Also match the date to the discovery/invention.(discovery of A,B,O blood types, Rh, Rhig introduced, etc.) Guess the object: Close up photos of various things around the lab taken at unusual angles. Shuffleboard with petri plates. I took photos of a couple of techs in various "poses" and then had them printed at 8x12 at Costco. Cut them out and you have lab action figures that you can copy and "decorate." Last time we did this, our good humored tech was was turned into a cannibal, ballerina, cowboy and showgirl. We also made "sculptures" from discarded (clean) lab items (gold foil from the tops of gel cards, pipette tip holders, etc.) On a more serious side, marketing is taking group photos and submitting them to the local paper and putting up 11x17 posters in the display cases. The napkin holders in the cafeteria have space for inserts. We were given permission to design an insert - probably the Get Results logo plus "Thank a lab professional for...." or interesting facts. We are also sending out an email to the entire hospital, with a little lab week blurb and then a 5 question trivia challenge, highlighting our work (how many tests are done/yr? What % of medical decisions are based on lab results? (70-80%!!!!)) This year we're also going to dumb down some of the word puzzles and put them in the OP waiting room so that the patients waiting for their lab draws will not notice how long they are waiting! For the staff, I got some Giant Microbes (also on Amazon) as prizes...you win SCABIES!!!!, SYPHILIS!!! MRSA, etc.

Thanks to everyone who took the time to reply.

The lab assistant will mainly have tasks in chemistry and with lab inventory, etc., but I may be able to snag her for some BB jobs. Since we are in California, MLTs are pretty limited in BB, so the CLSs will continue to do the bench work. CLS shortages in CA, our aging staff and our rural location make it hard to keep a strictly CLS staff these days. Thanks for your comments.

We have a new position in our lab - technical lab assistant. I have been asked to come up with some ideas of what this person could do to help. Suggestions have been; issuing products, receiving products and entering them into Meditech, thawing FFP and cryo. Does anyone have experience with this? What has worked and what hasn't. We may also be hiring an MLT. So feel free to figure that into the equation. Thanks for any help.

We ask that all orders are faxed. We have many (older) physicians ordering Type & Hold x2, which we see as a Type & Screen, but the unit secretaries and nursing staff often order as Type & Cross 2 units. Also the default in Meditech is for 2 units. If the person ordering is not paying attention and the provider only ordered 1, we end up crossing an extra. Our pathologist has devised a "Blood Product Order" form which the physician is supposed to complete. In addition to the order, the provider must check off the reason for the order, and any special requests (irr, autologous, etc.). Now we have to get them to consistently use it. The nursing staff also must bring this down to the lab when they come to pick up a product.

The OB dept sends cord bloods from all babies of Rh neg moms. If the cord blood is Rh positive, the lab orders a fetal screen and RHIG. If the RHIG is still sitting on the shelf at 48 hours, we call the OB dept.

We routinely split them into 5 samples, with each tech getting 1 specimen and doing the type, screen and xm. We just got CAP inspected and either they didn't have a problem with it or didn't notice.

Nope, the screening cells hadn't changed. I opened a new set of bottles, also...just in case. Thanks for the suggestion.

Has anyone had problems with Anti-IgG gel cards lot # 121409001-31 exp 27OCT10? We had a problem a few lots ago and Ortho replaced our cards and the new lot was fine. Now we are having problems again with junky specks in both patients and QC. The cell button ins't disturbed, nor is it going up the side. Thanks.